Glasgow Coma Scale Score In Patients Research Articles

Factors influencing the therapeutic failure of high-flow nasal cannula oxygen humidification in patients with interstitial pneumonia complicated by respiratory failure.

The aim of this study was to explore the factors influencing the treatment failure of high-flow nasal cannula (HFNC) therapy in patients with interstitial pneumonia (IP) complicated by respiratory failure. A total of 158 patients with IP and respiratory failure treated with HFNC in our hospital from January 2020 to August 2023 were selected as the study population. Based on treatment efficacy, they were categorized into the HFNC treatment failure group and the HFNC treatment success group. Clinical data were compared between the two groups. Multiple logistic regression analysis was employed to identify independent factors influencing treatment failure, and the predictive value of these factors for HFNC treatment failure was assessed using receiver operating characteristic (ROC) curve analysis. After 7 days of HFNC treatment, among the 158 patients with IP and respiratory failure, 25 (15.8%) declared treatment failure, while the remaining 133 (84.2%) showed treatment success. Patients in the HFNC treatment failure group had significantly higher age, duration of IP, pre-treatment respiratory rate, C-reactive protein (CRP), and controlling nutritional status (CONUT) scores compared to the HFNC treatment success group. The PaO2/FiO2 ratio, left ventricular ejection fraction, and Glasgow Coma Scale (GCS) were significantly lower in the HFNC treatment failure group (p<0.05). Multiple logistic regression analysis revealed that pre-treatment PaO2/FiO2 ratio, CRP, CONUT, and GCS scores were independent factors influencing HFNC treatment failure in patients with IP and respiratory failure (p<0.05). Lower PaO2/FiO2 ratio and GCS scores, and higher CRP and CONUT scores were associated with an increased risk of HFNC treatment failure. ROC curve analysis indicated that pre-treatment PaO2/FiO2 ratio, CRP, CONUT, and GCS scores in patients with IP and respiratory failure had a high predictive value for HFNC treatment failure (p<0.05). The HFNC failure rate in patients with IP and respiratory failure is 15.8%. Pre-treatment PaO2/FiO2 ratio, CRP, CONUT, and GCS scores are independent factors associated with HFNC treatment failure and warrant clinical attention.

Association Between Serum Electrolyte Disturbances and Glasgow Coma Scale Score in Patients With Diffuse Axonal Injury

Background: Appropriate clinical measures to prevent secondary brain damage in traumatic brain injury are of critical importance. Objectives: This study aims to investigate the relationships between serum electrolyte disturbances and Glasgow Coma Scale (GCS) score in patients with Diffuse Axonal Injury (DAI) at the time of admission and discharge. Materials &amp; Methods: In this retrospective cross-sectional study, we evaluated 101 patients with DAI having GCS score &lt;15 admitted to Poursina Hospital in Rasht, Iran from 2019 to 2020. Based on the presence or absence of serum potassium (K), sodium (Na), magnesium (Mg), and zinc (Zn), disturbances on the first day of hospitalization, patients were divided into two study groups of with and without abnormal electrolyte levels. The GCS scores of the two groups at the time of admission and discharge were recorded and the relationship between electrolyte disturbances and GCS score was evaluated. Results: There were no significant differences in the mean GCS score at the time of admission and discharge between patients with and without disturbances in serum Na, K, Zn and Mg levels based on the crude analysis. Regarding the simultaneous effects of the study variables on the GCS score, only Mg serum level exerted a significant impact on the GCS score at the time of admission (P=0.041) and discharge (P=0.017). Conclusion: The GCS score in patients with DAI at the time of admission and discharge has an association with the Mg serum level but not with Na, K, and Zn levels.

Magnesium Sulfate Therapy's Effects on GCS Scores in Patients with Severe TBI

Objective: The main purpose of this study is to examine whether or not magnesium sulphate improves the Glasgow Coma Scale (GCS) scores of individuals who have suffered severe traumatic brain injury. Study Design: Prospective study Place and Duration: Women medical college Abbottabad and Department of Neurology Hayatabad Medical Complex, during from Jan, 2021 to June, 2021. Methods: This research includes 72 participants of both sexes. Patients were between the ages of 18 and 55 when they were enrolled. All the patients had severe traumatic brain injury and magnesium sulphate treatment was administered to each patient. All of the patients' demographic information was obtained after they signed an informed permission form. In this study, the Glasgow coma score (GCS) was measured on the first and forth days of hospitalization, respectively. The SPSS 20.0 version was used to analyze all of the data. Results:Amon 73 included patients,males were higher in numbers 41 (56.9%) than females 31 (43.1%). Presented patients had mean age 43.6±9.39 years and had mean BMI 25.8±12.83 kg/m2 . Post traumatic mean time of brain injury was 6.16 ±4.41 hours. At first day without magnesium sulfate mean GCS of the patients was 7.3±8.30 but at the 4th day GCS was 11.9±6.42 with p value &lt; 0.04. GCS, on the other hand, showed no significant differences between gender and illness duration. Conclusion: The results of this study led us to the conclusion that the use of magnesium sulphate was an effective method for treating traumatic brain injury in patients. GCS was improved among patients when magnesium sulphate was administered on the seventh day. Keywords: Magnesium Sulfate, traumatic brain injury, Glasgow Coma Score (GCS)

Association between Glasgow Coma Scale in Early Carbon Monoxide Poisoning and Development of Delayed Neurological Sequelae: A Meta-Analysis.

A significant number of people experience delayed neurologic sequelae after acute carbon monoxide (CO) poisoning. The Glasgow Coma Scale (GCS) can be used to predict delayed neurologic sequelae occurrence efficiently and without any restrictions. Here, we investigated the association between a low GCS score observed in cases of early CO poisoning and delayed neurologic sequelae development through a meta-analysis. We systematically searched MEDLINE, EMBASE, and the Cochrane Library for studies on GCS as a predictor of delayed neurologic sequelae occurrence in patients with CO poisoning in June 2021. Two reviewers independently extracted study characteristics and pooled data. We also conducted subgroup analyses for the cutoff point for GCS. To assess the risk of bias of each included study, we used the quality in prognosis studies tool. We included 2328 patients from 10 studies. With regard to patients with acute CO poisoning, in the overall pooled odds ratio (OR) of delayed neurologic sequelae development, those with a low GCS score showed a significantly higher value and moderate heterogeneity (OR 2.98, 95% confidence interval (CI) 2.10–4.23, I2 = 33%). Additionally, in subgroup analyses according to the cutoff point of GCS, the development of delayed neurologic sequelae was still significantly higher in the GCS < 9 group (OR 2.80, 95% CI 1.91–4.12, I2 = 34%) than in the GCS < 10 or GCS < 11 groups (OR 4.24, 95% CI 1.55–11.56, I2 = 48%). An initial low GCS score in patients with early CO poisoning was associated with the occurrence of delayed neurologic sequelae. Additionally, GCS was quickly, easily, and accurately assessed. It is therefore possible to predict delayed neurologic sequelae and establish an active treatment strategy, such as hyperbaric oxygen therapy, to minimize neurological sequelae using GCS.

Predictors of favorable outcomes for vertebrobasilar artery occlusion after endovascular therapy within 24 hours of symptom onset

ObjectiveThe aim of the present study was to describe our results of endovascular therapy (EVT) for vertebrobasilar artery occlusion (VBAO) within 24 h of symptom onset, and to evaluate prognostic factors associated with favorable outcomes. MethodsThe present study enrolled patients who underwent EVT for acute ischemic stroke (AIS) caused by VBAO. Inclusion criteria for EVT to treat VBAO were as follows: (1) computed tomography angiography (CTA) or magnetic resonance angiography (MRA) confirmed acute VBAO; (2) baseline National Institutes of Health Stroke Scale (NIHSS) score ≥2; (3) premorbid modified Rankin scale (mRS) score ≤2; (4) onset or last known time to puncture within 24 h; and (5) posterior-circulation Acute Stroke Prognosis Early CT score (pc-ASPECTS) ≥6. Favorable outcomes were defined as mRS scores of 0–3 at three months following EVT. The associations among baseline parameters, procedural parameters, and favorable outcomes were assessed. ResultsA total of 67 patients were recruited in this study, of which 40 patients (59.7 %) had favorable outcomes. Of the 50 patients with a late-window (6–24 h), 29 patients (58 %) had favorable outcomes. Univariate analysis revealed significant associations of the following parameters with favorable outcomes in the enrolled patients: age, sex, smoking status, baseline NIHSS score, baseline Glasgow coma scale (GCS) score, Pons-midbrain index (PMI), and intracranial atherosclerosis (ICAS). Multivariate logistic regression indicated that only age (OR 0.914, 95 % CI: 0.849 to 0.984; p = 0.017), baseline GCS score (OR 1.234, 95 % CI: 1.061–1.435; p = 0.006), and PMI (OR 0.448, 95 % CI: 0.252 to 0.798; p = 0.006) were independently associated with favorable outcomes at three months following EVT. After adjustments for confounding factors in patients with a late-window, only age (OR 0.879, 95 % CI: 0.799 to 0.967; p = 0.008) was associated with favorable outcomes. ConclusionsYounger age, lower PMI, and higher GCS scores in patients with VBAO-induced AIS were associated with more favorable outcomes. In late-window (6–24 h) patients, younger age associated to favorable outcomes, and lower NIHSS scores and lower PMI each also had a tendency to associated with favorable outcomes.

The reliability of the Glasgow Coma Scale in detecting traumatic brain injury: The continuous effect of age

ABSTRACTBackground: Recent studies noted the limited applicability of Glasgow Coma Scale (GCS) for elderly patients with Traumatic Brain Injury (TBI). However, the dichotomic distinction between "elderly" and "non-elderly" does not cover the full span of influence of age on GCS presentation.Objective: To analyze the influence of age on GCS scores of patients with isolated TBI.Methods: A retrospective study of 18,534 patients hospitalized due to isolated TBI recorded in the Israeli National Trauma Registry in 1997-2017. The GCS scores were compared between four age-groups: 20-44, 45-64, 65-74 and 75+ years old. Additional factors included patient's sex, Abbreviated Injury Scores (AIS) and injury circumstances.Results: GCS scores increased continuously with age at all AIS levels. The trend was significant even after adjustment for patient's sex and injury circumstances. The angle of the trend was different in various injury circumstances, with GCS scores of victims of Road Traffic Accidents sharply increasing after age of 44 and that of the patients hospitalized after falling from own height surging after age of 64.Conclusions: Screening procedures for patients with TBI should give a greater weight to the actual age of adults, as well as to the circumstances of their injury.

The Reverse Shock Index Multiplied by Glasgow Coma Scale Score (rSIG) and Prediction of Mortality Outcome in Adult Trauma Patients: A Cross-Sectional Analysis Based on Registered Trauma Data.

The reverse shock index (rSI) multiplied by Glasgow Coma Scale (GCS) score (rSIG), calculated by multiplying the GCS score with systolic blood pressure (SBP)/hear rate (HR), was proposed to be a reliable triage tool for identifying risk of in-hospital mortality in trauma patients. This study was designed to externally validate the accuracy of the rSIG in the prediction of mortality in our cohort of trauma patients, in comparison with those that were predicted by the Revised Trauma Score (RTS), shock index (SI), and Trauma and Injury Severity Score (TRISS). Adult trauma patients aged ≥20 years who were admitted to the hospital from 1 January 2009 to 31 December 2017, were included in this study. The rSIG, RTS, and SI were calculated according to the initial vital signs and GCS scores of patients upon arrival at the emergency department (ED). The end-point of primary outcome is in-hospital mortality. Discriminative power of each score to predict mortality was measured using area under the curve (AUC) by plotting the receiver operating characteristic (ROC) curve for 18,750 adult trauma patients, comprising 2438 patients with isolated head injury (only head Abbreviated Injury Scale (AIS) ≥ 2) and 16,312 without head injury (head AIS ≤ 1). The predictive accuracy of rSIG was significantly lower than that of RTS in all trauma patients (AUC 0.83 vs. AUC 0.85, p = 0.02) and in patients with isolated head injury (AUC 0.82 vs. AUC 0.85, p = 0.02). For patients without head injury, no difference was observed in the predictive accuracy between rSIG and RTS (AUC 0.83 vs. AUC 0.83, p = 0.97). Based on the cutoff value of 14.0, the rSIG can predict the probability of dying in trauma patients without head injury with a sensitivity of 61.5% and specificity of 94.5%. The predictive accuracy of both rSIG and RTS is significantly poorer than that of TRISS, in all trauma patients (AUC 0.93) or in patients with (AUC 0.89) and without head injury (AUC 0.92). In addition, SI had the significantly worse predictive accuracy than all of the other three models in all trauma patients (AUC 0.57), and the patients with (AUC 0.53) or without (AUC 0.63) head injury. This study revealed that rSIG had a significantly higher predictive accuracy of mortality than SI in all of the studied population but a lower predictive accuracy of mortality than RTS in all adult trauma patients and in adult patients with isolated head injury. In addition, in the adult patients without head injury, rSIG had a similar performance as RTS to the predictive risk of mortality of the patients.

Bispectral index value correlates with Glasgow Coma Scale in traumatic brain injury patients.

BackgroundAccuracy of consciousness level assessment is very important. It may determine and influence further clinical decisions, thus influences patients’ outcomes. The widest method in determining the level of awareness is the Glasgow Coma Scale (GCS). Despite its common use, GCS scores obtained by one clinician may differ from others depending on their interpretations and past experience. One of the tools used to assess the level of consciousness objectively is bispectral index (BIS). The aim of this study was to identify the correlation between BIS and GCS score in patients with traumatic brain injury.Patients and MethodsA total of 78 patients who were admitted to emergency room for traumatic brain injury were included in this study. One observer evaluated the GCS of all patients to minimize subjectivity. Another investigator then obtained the BIS values for each patient. Spear-man’s rank correlation coefficient was used to determine whether GCS correlated with BIS value.ResultsIn 78 patients, the BIS was found to be significantly correlated with GCS (r=0.744, p<0.01). The BIS values increased with an increasing GCS. Mean BIS values of mild, moderate, and severe head injury were 88.1±5.6, 72.1±11.1, and 60.4±11.7, respectively.ConclusionIn this study, a significant correlation existed between GCS and BIS. This finding suggests that BIS may be used for assessing GCS in patients with traumatic brain injury. However, the scatters of BIS values for any GCS level may limit the BIS in predicting GCS accurately.

Moderate and severe traumatic brain injury: effect of blood alcohol concentration on Glasgow Coma Scale score and relation to computed tomography findings.

The influence of alcohol is assumed to reduce consciousness in patients with traumatic brain injury (TBI), but research findings are divergent. The aim of this investigation was to study the effects of different levels of blood alcohol concentration (BAC) on the Glasgow Coma Scale (GCS) scores in patients with moderate and severe TBI and to relate the findings to brain injury severity based on the admission CT scan. In this cohort study, 265 patients (age range 16-70 years) who were admitted to St. Olavs University Hospital with moderate and severe TBI during a 7-year period were prospectively registered. Of these, 217 patients (82%) had measured BAC. Effects of 4 BAC groups on GCS score were examined with ordinal logistic regression analyses, and the GCS scores were inverted to give an OR > 1. The Rotterdam CT score based on admission CT scan was used to adjust for brain injury severity (best score 1 and worst score 6) by stratifying patients into 2 brain injury severity groups (Rotterdam CT scores of 1-3 and 4-6). Of all patients with measured BAC, 91% had intracranial CT findings and 43% had BAC > 0 mg/dl. The median GCS score was lower in the alcohol-positive patients (6.5, interquartile range [IQR] 4-10) than in the alcohol-negative patients (9, IQR 6-13; p < 0.01). No significant differences were found between alcohol-positive and alcohol-negative patients regarding other injury severity variables. Increasing BAC was a significant predictor of lower GCS score in a dose-dependent manner in age-adjusted analyses, with OR 2.7 (range 1.4-5.0) and 3.2 (range 1.5-6.9) for the 2 highest BAC groups (p < 0.01). Subgroup analyses showed an increasing effect of BAC group on GCS scores in patients with Rotterdam CT scores of 1-3: OR 3.1 (range 1.4-6.6) and 6.7 (range 2.7-16.7) for the 2 highest BAC groups (p < 0.01). No such relationship was found in patients with Rotterdam CT scores of 4-6 (p = 0.14-0.75). Influence of alcohol significantly reduced the GCS score in a dose-dependent manner in patients with moderate and severe TBI and with Rotterdam CT scores of 1-3. In patients with Rotterdam CT scores of 4-6, and therefore more CT findings indicating increased intracranial pressure, the brain injury itself seemed to overrun the depressing effect of the alcohol on the CNS. This finding is in agreement with the assumption of many clinicians in the emergency situation.

Bacterial brain abscesses: prognostic value of an imaging severity index

To assess the correlation between imaging findings [computed tomography (CT) or magnetic resonance imaging (MRI)] and neurological status before and after the treatment of bacterial brain abscesses. CT and MRI images of 96 patients with brain abscesses were retrospectively evaluated in terms of the number, location and size of lesions, and the presence and extent of perilesional oedema and midline shift. An imaging severity index (ISI) based on these different radiological parameters was calculated. Initial Glasgow Coma Scale (GCS) scores and ISI were assessed and the prognostic value of these two indices was calculated. The Pearson correlation test, Mann-Whitney test, Chi-square test, receiver-operating characteristic (ROC) analysis, together with comparison of ROC analyses and Fisher's exact test were used. There was a negative correlation between ISI and the initial GCS values: ISI increased as the GCS score decreased, indicating an inverse relationship (r=-0.51, p<0.0001). There was a significant difference between the ISI and GCS scores of patients with an adverse event compared with patients with good recovery. Outcome was significantly worse in patients with initial ISI over the calculated cut-off values of 8 points or GCS scores under the cut-off value of 13 points. ISI is a useful prognostic indicator for bacterial brain abscess patients and correlates strongly with the patient outcome for all parameters studied. ISI score had a better prognostic value than GCS.

Time-level relationship between indicators of oxidative stress and Glasgow Coma Scale scores of severe head injury patients

Oxidative stress is said to strongly influence the neurological recovery of patients following a severe head injury. Estimation of the markers of oxidative stress in the blood of such patients can hence aid in predicting the prognosis of head injury. Erythrocyte thiobarbituric acid-reactive substances (TBARS) and plasma ceruloplasmin (CP) levels were estimated in 24 severe head-injury patients on days 1, 7 and 21 of the post-traumatic period and compared with levels in 25 healthy age- and sex-matched controls. These parameters reflecting oxidative stress status were related to the Glasgow Coma Scale (GCS) scores of patients noted at the same time points of the study period. Lipid peroxidation as indicated by increased levels of erythrocyte TBARS remained significantly elevated in severe head injury patients compared to controls on day 1 (p<0.001), day 7 (p<0.001) and 21 (p<0.001) of the post-traumatic period. Plasma CP levels remained significantly elevated (p<0.001) at these three time points compared to controls. The significant decrease in lipid peroxidation products (p<0.01) and significant increase in CP levels (p<0.001) on day 21 compared to day 1 in head injury patients correlated well with the significant improvement in GCS scores of patients on day 21 compared to day 1 (p<0.05). The above results could account for the adaptation of the study patients to severe oxidative stress, as evidenced by their clinical recovery trend during the study period.

Prognostic Value and Determinants of Ultraearly Angiographic Vasospasm after Aneurysmal Subarachnoid Hemorrhage

Prognostic Value and Determinants of Ultraearly Angiographic Vasospasm after Aneurysmal Subarachnoid Hemorrhage

Hemorrhagic dilation of the fourth ventricle: an ominous predictor

Very little is known about the effect of computerized tomography (CT)-documented fourth intraventricular hemorrhage (IVH). An analysis of 50 patients with CT-documented fourth IVH treated between 1987 and 1992 is presented. The various etiologies included intraparenchymal hemorrhage with secondary fourth IVH (19 cases), spontaneous subarachnoid hemorrhage (18 cases), spontaneous IVH (seven cases), and trauma (six cases). Overall, 28 patients (56%) had hemorrhagic dilation of the fourth ventricle and all 28 suffered brain death, despite aggressive therapy in 79% of cases. Twenty-two patients (44%) had fourth IVH without dilation; of these, nine (41%) died and 13 (59%) experienced functional survival, despite aggressive care in 90% of cases. The survival rate was significantly worse for patients with dilation of the fourth ventricle (p < 0.01, chi-squared test). Of the 28 patients with fourth IVH associated with dilation, 25 (89%) had diffuse clot, involving the lateral and third ventricles as well, and three (11%) had isolated fourth IVH. Of the 22 patients with fourth IVH and no dilation, 13 (59%) had diffuse IVH (eight of these died and five had functional recovery) and nine (41%) had isolated fourth IVH (one died and eight had functional recovery). Diffuse ventricular clot was associated with an increased mortality rate for patients with fourth IVH and no dilation (p < 0.05). Of the 28 patients with fourth IVH associated with dilation, 24 (86%) presented with a Glasgow Coma Scale (GCS) score of 3 or 4, one with a GCS score of 6, and three with a GCS score of 13 to 15; all 28 died. For the 22 patients with fourth IVH and no dilation, nine presented with a GCS score of 3 to 5 (eight died and one had functional recovery), three had a GCS score of 6 to 8 (all three had functional survival), two had a GCS score of 9 to 12 (both had functional survival), and eight had a GCS score of 13 to 15 (one died and seven had functional survival). There was a greater chance of higher GCS scores in patients with fourth IVH and no hemorrhagic dilation (p < 0.01). Logistic regression multivariate analysis showed hemorrhagic fourth ventricular dilation to be the most significant outcome predictor (p = 0.0001), followed by GCS score (p = 0.007) and the presence of diffuse IVH (p = 0.0279).